Modifications are suggested for the Special Interest Group (SIG) on Neuropathic Pain proposed definition and guidelines for neuropathic pain.

摘要

We write to express concern regarding the SIG on Neuropathic Pain definition and guidelines for neuropathic pain recently revised in a review with recommendations [1]. The requirement that positive sensory findings (allodynia, hyperesthesia, hyperalgesia) be "confined to the innervation territory of the lesioned neural structure" has not been validated; furthermore, it is inconsistent with the current evidence. Preclinical science in animal models has demonstrated extraterritorial sensory findings after nerve lesions resulting from expanding receptive fields of spinal dorsal horn neurons [7]. This is consistent with the clinical presentation in persons with pain conditions after nerve injury [2,4,9]. In 2008, the SIG on Neuropathic Pain Task Force acknowledged extraterritorial sensory findings due to central sensitization [8]. In fact, the existence of extraterritorial pain and sensory findings are a necessary clinical correlate of the putative pathophysiological phenomenon of central sensitization [3,5]. In our clinics, we frequently see patients with neuropathic pain, and many of them exhibit extraterritorial positive sensory findings.